1

The life and death issue of superbugs

Antibiotic resistance is a serious public health issue and you can help prevent the spread of it, writes Phillip Nikolic.

By now you should be familiar with antibiotic resistance. At the very least, you would have heard of golden staph, which in layman’s terms is a superbug. In medical terms, golden staph is known as methicillin-resistant Staphylococcus aureus. You don’t have to have a major wound to get golden staph, it can develop from even a minor wound. Therefore, antibiotic resistance is a life and death matter, and knowing what causes it can help save lives.

For those who haven’t heard, antibiotic resistance occurs when bacteria change in some manner and behave differently to resistant antibiotic treatment. This can be through random mutations or the acquisition of mobile genetic elements.

This includes neutralising the antibiotic, changing the cellular component that the antibiotic acts on, preventing the antibiotic from reaching its target site or replacing the disrupted pathway through alternative means.

Antibiotic resistance is a serious threat and according to Dr Sergio Diez Alvarez, a former member of the New South Wales Government Clinical Excellence Commission Antimicrobial Stewardship Expert Advisory Committee, there is “not enough education on antibiotic stewardship.”

Much of what you do with the intent of avoiding or curing illnesses may actually be contributing to it. You are almost certainly not doing this intentionally or with ill intent. There are several very easy steps that you can take to help minimise the spread of resistance which you will find summarised in a helpful list below.

Only take antibiotics when appropriate

Antibiotics by definition are only effective against bacteria. Yet how often have you or someone you know come down with a cold or the flu and rushed to your doctor and asked for some antibiotics? These infections are caused by viruses, antibiotics have no effect on them. What they will do in this case is create an antibiotic rich environment that selects for resistant strains; a breeding ground for resistance. It is for this reason that it is important that you listen to your doctor when they say that antibiotics won’t help a flu, and you should not pressure them to prescribe what they don’t think will help.

Take your full course of antibiotics

When you are prescribed antibiotics you are also given a course to follow. However, you may start to feel better before you are done with it. You may feel you are cured and stop taking the pills. The problem with this is that just because you feel better doesn’t mean that the infection is completely cured. You run the risk of the infection returning worse than before, potentially as a strain that has developed resistance.

Recently, there has been a reignition in the debate as to whether or not a shorter course of antibiotics is better. Still the best course of action is to take the antibiotics as prescribed by your doctor as this prescription should be based on the latest in clinical evidence. Furthermore, do not share your antibiotics with anyone else. They may not be appropriate for them or their infection, potentially making them sicker. It also increases the chance of resistance developing due to antibiotic overuse.

Do not use antibacterial soaps

Antibacterial hand soaps and wipes for use in the home are unnecessary and do not provide a benefit above that of soap and water. These products target specific cellular components that create antibiotic resistance through prolonged exposure. Ordinary soaps and alcohol-based sanitisers are a better alternative to using antibacterial hand soaps and wipes. Soap loosens and lifts contaminants from surfaces cleaning your hands and preventing resistance from developing. Alcohol based sanitisers inflict massive damage to the cell and then evaporates away. Residue does not remain for resistance to develop from constant exposure whereas antibacterial cleaners leave residue creating a resistance selecting environment.

The negative impact of antibacterial soaps is known. In 2017 the U.S. Food and Drug Administration ruled that antibacterial soaps containing any of 19 specific active ingredients including triclosan and triclocarban were no longer to be marketed as “manufacturers did not demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illness and the spread of certain infections”.

While not illegal in Australia, these were still removed from many Australian products and a new formula made to replace it. Even so, these antibacterial soaps are no better than old fashioned soap and water and come with the potential to spread resistance. It is best to steer clear from them outside of clinical settings.

Do not purchase meat from suppliers that use antibiotics as growth promoters

Antibiotics aren’t only used to treat bacterial infections in humans. They are also used to treat and prevent infections in animals and in agriculture to optimise animal health. This practice leads to antibiotics entering the food chain and the environment. The impact of this on anti-microbial resistance patterns still needs to be further examined. “We need to look more closely at whether this has an adverse impact,” and whether or not the risk on antimicrobial resistance development of this animal husbandry practice needs closer regulatory monitoring,” said Dr Diez Alvarez.

There are limitations on what antibiotics, and how much of them, can be used in agriculture. But there are cases where antibiotics will still be used when it is not necessarily the best course of action to take. For these reasons it is best to not purchase meat that has come from a farm using antibiotics, organic meat for example is a better alternative.

Antibiotics are amazing. But if we keep abusing them like we have been then we will have to live without them. If we lose antibiotics it will mean unnecessary deaths from an infection that could have been cured with a pill. The first step is proper education on resistance and what we can do to stop it. I hope you will take to heart what you have read here today and keep an eye out for better behaviours you can adopt.

Additional information

The Australian Commission on Safety and Quality in Health Care (ACSQHC) is a government agency that uses the best available evidence to improve Australian clinical practices. As part of this, the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System was established and monitors the use of antimicrobials and the development of resistant strains of bacteria. As part of the ACSQHC’s 2017 report, several key findings were identified that highlight the threat of resistance and what we are doing wrong. In brief, the findings included:

Medical doctors over-prescribed antibiotics to patients. In winter, more antibiotics are prescribed than the rest of the year for cold and flu. This is ineffective and only helps to spread resistance and subject patients to unnecessary side effects.
Several strains of infectious bacteria showed a strong increase in antibiotic resistance. Australia has some of the highest rates of antibiotic resistance in the world.

Resistant strains of Staphylococcus aureus – golden staph –  that arose in the community have become more common than resistant strains from hospitals. This implicates poor practices in the home as contributing to resistance spreading.
In summary, antibiotic resistance it not only spreading in hospitals, but also in the home and you can help prevent it.